The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: A systematic review, thematic synthesis and modelling of the literature

BACKGROUND

Socially excluded populations have poorer access to care; however, little attention has been paid to lesbian, gay, bisexual and/or trans* people. Lesbian, gay, bisexual and/or trans* people are at increased risk of certain life-limiting illnesses and may not receive the care and support they need at the end of life and into bereavement.

AIM

To identify and appraise the evidence of the bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner and develop an explanatory model of lesbian, gay, bisexual and/or trans* partner bereavement.

DESIGN

Systematic review (in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) and thematic synthesis with assessment of reporting and rigour. Quantitative or qualitative articles reporting bereavement experiences of lesbian, gay, bisexual and/or trans* partners were included, excluding articles reporting multiple losses in the context of HIV or AIDS.

DATA SOURCES

PsycINFO, MEDLINE, Web of Science, Scopus, Cochrane Library. Inclusion dates: database inception - 30 April 2015.

RESULTS

A total of 23 articles reporting on 13 studies were identified. Studies described universal experiences of the pain of losing a partner; however, additional barriers and stressors were reported for lesbian, gay, bisexual and/or trans* people, including homophobia, failure to acknowledge the relationship, additional legal and financial issues and the 'shadow' of HIV or AIDS. A novel model was developed to explain how the experience for lesbian, gay, bisexual and/or trans* people is shaped by whether the relationship was disclosed and acknowledged in life and into bereavement and how this impacts upon needs and access to care.

CONCLUSION

There is a need for healthcare providers to avoid hetero-normative assumptions; be mindful of additional stressors in bereavement for lesbian, gay, bisexual and/or trans* people; and consider additional sources of support to deliver individualised holistic care.

Online Grief Support Communities

Online grief support communities have become popular in recent years for those seeking information and empathetic others following the death of someone close to them. Hundreds of Facebook pages and Web sites are now devoted to bereavement—and health-care professionals need to assess what therapeutic benefits virtual communities might offer to help people manage grief and integrate death into their lives. In the current study of online grief support networks ( N = 185), individuals report less psychological distress as a result of joining these groups—and this psychosocial benefit increased over time. Individuals who were members for a year or more characterized their grief as less severe compared with those who had a shorter tenure in the community. Additional findings and implications are discussed.

Stuck in the past: negative bias, explanatory style, temporal order, and evaluative perspectives in life narratives of clinically depressed individuals

This study attempted to replicate negative bias and depressive explanatory style in depression using life narratives. The two central aspects of narrative, temporal succession and evaluation, were also explored. These aspects were tested for the first time using entire life narratives of 17 depressed inpatients and non-depressed controls matched for sex and educational level. Negative bias and depressive explanatory style were replicated as typical for the depressed group. Life narratives of depressed patients also deviated more from a linear temporal order and compared less frequently the past with the present. Contrary to expectations, the depressed did not differ in the overall frequency of evaluations. However, they used more past than present evaluations and more experience-near evaluations than cognitive evaluations, suggesting that they are more immersed in past experiences. It is concluded that negative bias and depressive explanatory style can be found also in a naturalistic narrative measure, and that depression affects the two major aspects of narrative. It is argued that life narratives, as measures close to everyday clinical practice and as the most encompassing form of self-representation, should complement more experimental procedures in the study of cognitive and communicative processes in psychopathology.

Coping with AIDS-related bereavement in KwaZulu-Natal, South Africa

This qualitative study explored how South Africans view and cope with AIDS-related loss. In-depth interviews were conducted with a purposive sample of 18 bereaved adults living in KwaZulu-Natal, a province that has been severely impacted by the HIV/AIDS epidemic. Data were analysed according to the conventions of qualitative research. Participants felt quite powerless and accepted AIDS-related deaths as a part of their life. They tried to reframe their loss as something positive; constructing meaning from their loss. Coping strategies included: suppressing emotions; seeking comfort and strength from one's spiritual beliefs; and maintaining an optimistic attitude about the future. These themes are consistent with research on coping with AIDS-related bereavement in the West. Further research is needed to confirm these themes in the South African context using culturally appropriate measures. Future interventions must be tailored to the local context and must take into consideration the limited availability of funds for mental health services in South Africa.